Switching Antipsychotics: Why, When, and How?
نویسنده
چکیده
At the end of this article, readers should be able to: 1. Describe the reasons for switching an antipsychotic. 2. Assess the optimum time to switch. 3. Recognize the best ways to switch. The need to switch from one antipsychotic drug to another is a frequent challenge in the long-term management of patients with schizophrenia and related psychotic disorders, even when an antipsychotic that is effective for managing acute symptoms is continued during maintenance treatment. For instance, antipsychotic discontinuation rates ranged from 64% (for olanzapine) to 82% (for quetiapine) in the first phase of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, despite evidence indicating clinical improvement.1 Although low treatment adherence contributes to the high rates of antipsychotic switching observed in clinical practice, there are specific instances in which deliberately switching from one antipsychotic drug to another is warranted. When switching occurs, the clinical effects (both positive and negative) are uncertain, thus posing considerable challenges to practitioners. Familiarity with common indications (and contraindications) for switching antipsychotics, strategies for selecting and switching medications, and important psychosocial considerations can help patients attain optimal therapeutic outcomes while minimizing the risk of adverse events—including relapse. Indications for antipsychotic switching Indications for switching antipsychotic drugs in patients with schizophrenia or bipolar disorder12-14
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